Abstract
Pancreatic pseudocyst from pancreatic duct leak is one of the common complications of both acute and chronic pancreatitis. The presentation of such leaks can range from patients being completely asymptomatic to septic shock. Extra-abdominal collections of fluid due to pancreatic duct leaks are very rare. We describe a diagnostically challenging patient with acute chronic pancreatitis presenting with lower extremity swelling and pain, who was found to have a pancreatic fluid leak into the right iliopsoas, right gluteal, and thigh muscle compartment. Despite endoscopic stenting of the pancreatic duct and multiple percutaneous drain placement and antibiotic treatment for abscess formation, the patient's condition deteriorated clinically. Surgical options could not be pursued due to poor functional status.
Highlights
Pancreatic duct leak may arise from acute and chronic pancreatitis, or as a complication of surgery or trauma
The progression of pancreatic duct leak can result in the development of various clinical entities including pseudocyst formation, pleural effusion, ascites, and pancreatic fistulas
In patients with chronic pancreatitis, the leakage typically occurs due to stricture development or intraductal stones [2]
Summary
Pancreatic duct leak may arise from acute and chronic pancreatitis, or as a complication of surgery or trauma. We describe a case of pancreatic duct leak resulting in an iliopsoas and thigh fluid collection presenting with pain and edema of the right lower extremity. Due to concern for acute pancreatitis, CT of the abdomen and pelvis was obtained, which showed pancreatic calcifications and associated intrahepatic and extrahepatic biliary ductal dilation, as well as main duct dilatation with stones seen in the gallbladder In addition to these findings, a large 5.6 x 3.8 cm multiloculated abscess collection involving the right iliopsoas and multiple right gluteal musculature abscesses, the largest of which was 5.7 x 2.2 cm in the gluteus maximus, was noted. Despite continued drainage and octreotide treatment, repeat imaging on day 15 of hospitalization showed increased fluid collections in the musculature of the right hemipelvis and proximal right thigh. On day 25 of admission, the patient was transferred to a skilled nursing facility with hospice care
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